Symptomatic Tarlov Cysts Research Articles

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant.

There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients' symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing. This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3-6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3-6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications. The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk.

Tarlov Cysts: clinical evaluation of an Italian cohort of patients

Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.

Microsurgical Treatment of a Complex Sacral Perineural Cyst Using Paraspinous Muscle Flap: Technical Note

Microsurgical Treatment of a Complex Sacral Perineural Cyst Using Paraspinous Muscle Flap: Technical Note Dr. I.M. Tarlov first described perineural (Tarlov) cysts in 1938. Symptomatic Tarlov cysts are common incidental findings yet uncommon clinical/pathologic entities. Microsurgical treatment of Tarlov cysts is even more rare. We report the microsurgical treatment of a symptomatic complex Tarlov cyst as a case. The patient presented with sacral pain, bilateral sciatica (S1-type), urinary retention, rectal pain with intercourse, gluteal heaviness, and intermittent burning in the S2-4 dermatome. MR imaging revealed a complex sacral Tarlov cyst with bony erosion. The patient was treated microsurgically and had a paraspinous muscle flap advancement procedure performed in conjunction with Plastic Surgery. The patient experienced a positive clinical outcome.

Thoracic Radiculopathy Secondary to Symptomatic Tarlov Cysts: A Case Report

Thoracic Radiculopathy Secondary to Symptomatic Tarlov Cysts: A Case Report

Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

Corrections: on Page 38 in the 4th line of text, the information in brackets (Figure 1, 2, 3a and 4) was replaced on 24th June 2013 with (Figure 1. 2 3b and 4). The number of the references has also been changed. The corrected PDF is available by clicking the link below.Aim: To analyze the characteristics of symptomatic Tarlov cysts by MRI. Materials and Methods: Neuroimaging and clinical outcome data were reviewed of 48 consecutive patients treated for symptomatic Tarlov cysts. All patients were scanned under Philips Gyroscan Intera 1.5T scanner with spinal surface coils. Two widely used surgical procedures were performed, 1) incision and drainage of the cyst with imbrication of the redundant nerve root sheath, and 2) exposure of the cyst, drainage of cyst contents, identification of nerve roots, and cyst wall resection combined with duraplasty. The post-operation follow-up was obtained from return visits to the neurosurgery and orthopaedic out-patient department or by telephone questionnaires. Results: All cystic lesions showed hypointense signal intensity on T1WI and hyperintense signal intensity on T2WI, but the nerve root showed iso-intensity on T1WI and low signal intensity on T2WI. They were linear in shape on sagittal view, and hypo intense dotted spots within the cysts on traverse view. Surrounding structures of the larger cysts were compressed and had bone erosions in some cases; the spinal canal and the intervertebral foramen on the affected side were enlarged. The lesions/cyst wall showed no enhancement after gadolinium administration. Conclusion: MRI will give a definite diagnosis of Tarlov cysts if nerve root presents within the cyst cavity or in the cyst wall; eliminating the need for histological confirmation. A correct analysis of the characteristics of symptomatic Tarlov cysts by MRI, will document its usefulness in noninvasive diagnosis and aid in exploration of the simplest treatment method. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8056 Asian Journal of Medical Sciences 4(2013) 35-42

Tarlov cysts: clinical evaluation of an italian cohort of patients

Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.

Multiple Giant Tarlov Cysts Presenting as Polyradiculopathy: A Rare Manifestation

We describe a case of multiple giant Tarlov cysts presenting with complaints of low back pain with neurological claudication. Tarlov cysts are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. Most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints. NJR I VOL 2 I ISSUE 1 57-60 Jan-June, 2012 DOI: http://dx.doi.org/10.3126/njr.v2i1.6984

Tarlov Cysts: An Overlooked Clinical Problem

Symptomatic Tarlov cysts typically cause chronic pelvic and lower extremity pain and sacral nerve root radiculopathy. Historically, open surgical treatment involved significant patient morbidity, particularly postoperative cerebrospinal fluid (CSF) leaks and infection. These CSF leaks often required multiple surgical procedures to seal. Over the past 20 years, there have been two or three isolated case reports of computed tomography (CT)-guided needle aspirations that offered limited evidence of treatment efficacy and safety. Some have reported high rates of postprocedure aseptic meningitis that were not well explained. These poor results dissuaded physicians from caring for these patients. As a group these patients are usually treated dismissively and told their cysts are asymptomatic and their pain must be coming from somewhere else. Many of them have had an unnecessary discectomy or a spinal fusion, and when these procedures did not relieve their pain they were told they are a "failed back patient." We have treated more than a hundred patients with symptomatic Tarlov cysts by CT fluoroscopic-guided needle aspiration and fibrin injection and have had excellent results with no meaningful complications and never a case of aseptic meningitis. We believe this is a safe, highly effective first-line treatment for symptomatic Tarlov cysts.

Sacral laminoplasty and cystic fenestration in the treatment of symptomatic sacral perineural (Tarlov) cysts: Technical case report

Background:Perineural cysts of the sacrum, or Tarlov cysts, are cerebrospinal fluid (CSF)-filled sacs that commonly occur at the intersection of the dorsal root ganglion and posterior nerve root in the lumbosacral spine. Although often asymptomatic, these cysts have the potential to produce significant symptoms, including pain, weakness, and/or bowel or bladder incontinence. We present a case in which the sacral roof is removed and reconstructed via plated laminoplasty and describe how this technique could be of potential use in maximizing outcomes.Methods:We describe technical aspects of a sacral laminoplasty in conjunction with cyst fenestration for a symptomatic sacral perineural cyst in a 50-year-old female with severe sacral pain, lumbosacral radiculopathy, and progressive incontinence. This patient had magnetic resonance imaging (MRI) and computed tomography (CT)-myelographic evidence of a non-filling, 1.7 × 1.4 cm perineural cyst that was causing significant compression of the cauda equina and sacral nerve roots. This surgical technique was also employed in a total of 18 patients for symptomatic tarlov cysts with their radiographic and clinical results followed in a prospective fashion.Results:Intraoperative images, drawings, and video are presented to demonstrate both the technical aspects of this technique and the regional anatomy. Postoperative MRI scan demonstrated complete removal of the Tarlov cyst. The patient's symptoms improved dramatically and she regained normal bladder function. There was no evidence of radiographic recurrence at 12 months. At an average 16 month followup interval 10/18 patients had significant relief with mild or no residual complaints, 3/18 reported relief but had persistent coccydynia around the surgical area, 2/18 had primary relief but developed new low back pain and/or lumbar radiculopathy, 2/18 remained at their preoperative level of symptoms, and 1/18 had relief of their preoperative leg pain but developed new pain and neurological deficits.Conclusions:Sacral laminoplasty and microscopic cystic fenestration is a feasible approach in the operative treatment of this difficult, and often controversial, spinal pathology. This technique may be used further and studied in an attempt to minimize potential surgical morbidity, including CSF leaks, cyst recurrence, and sacral insufficiency fractures.

Abstract No. 1: Efficacy and Safety of CT Fluoroscopic-Guided Needle Aspiration and Fibrin Injection of Symptomatic Tarlov Cysts: A Retrospective Analysis of 122 Patients

Symptomatic Tarlov cysts typically cause chronic pelvic and lower extremity pain. Current surgical treatment involves significant patient morbidity. The isolated case reports of CT-guided needle aspirations offer limited evidence of treatment efficacy and safety. We report the outcome of 122 patients with symptomatic Tarlov cysts treated at our institution by CT fluoroscopic guided needle aspiration and fibrin injection, surgical laminectomy and cyst fenestration, or both.

Learning specialist skills for a generalist discipline

<h3>BACKGROUND AND PURPOSE:</h3> There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients9 symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing. <h3>MATERIALS AND METHODS:</h3> This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3–6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). <h3>RESULTS:</h3> One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3–6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications. <h3>CONCLUSIONS:</h3> The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk.

Lombosciatique de causes inhabituelles : kystes de Tarlov et anomalies des racines nerveuses

Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.

Two-Needle Technique for the Treatment of Symptomatic Tarlov Cysts

Two-Needle Technique for the Treatment of Symptomatic Tarlov Cysts

Tarlov cyst: Case report and review of literature

We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints.